2024 Health Law Conference
Written By Paul Szydelko
Some fates are worse than death. For some dying patients, it’s the loss of autonomy. For others, it’s the loss of dignity. Terminally ill adults are legally able to choose to bring about their own death in a growing number of states.
That changing legal landscape around medical aid in dying (MAID) was the subject of the UNLV Health Law Program’s online conference in February. MAID is the procedure that legally allows a physician to prescribe a lethal dose of medicine for a mentally competent patient with a prognosis of less than six months to voluntarily self-administer to hasten death.
Over the past 25 years, ten states and Washington, D.C. (about 22 percent of the country’s population) have legalized MAID, and legalization is being considered by several others, including Nevada.
Dr. David Orentlicher, UNLV Health Law Program director and a Nevada assemblyman, led the conference. He co-sponsored an aid-in-dying bill approved by the legislature in 2023, but Gov. Joe Lombardo vetoed it. Orentlicher anticipates revisiting the issue in 2025.
“For the same reasons that the law has recognized a broad right to refuse life-sustaining treatment, the law is now recognizing a limited right to aid in dying,” Orentlicher said, outlining the moral and legal considerations. The evolving legal rules reflect the ethical view that when patients are greatly suffering from serious and irreversible illness, they may prioritize quality of life over length of life, he said.
Professors Maxim Gakh and Chris Cochran of the UNLV School of Public Health facilitated questions during the conference, which included presentations from around the continent.
Dr. Diana Barnard, palliative medicine specialist and an associate professor at the University of Vermont, said doctors and family members should listen closely to terminally ill patients, “who they are and how they have navigated their life,” to inform end-of-life decisions.
Dr. James Downar, a palliative care physician and professor at the University of Ottawa, provided a data-driven overview of the practice, which has been legal north of the border since 2016. Canada has vigilant oversight and almost 100 percent compliance with the law, he said, and palliative care usage and funding are increasing rapidly. Problems of poverty, inadequate social assistance and support, access and quality of palliative care and long-term care, and loneliness—causes of mortality and suffering—are not driving MAID to any substantial degree, he said.
Dr. Charles Blanke of Oregon Health & Science University, whose state was the trailblazer on the issue in the late 1990s, provided a timeline and data of states across the country.
Most patients in Oregon who pursued medical aid in dying cited the loss of autonomy, that they could not participate in enjoyable activities, or the loss of dignity. About 28 percent cited poor pain control, and 5 percent cited the cost of therapy—more worrisome reasons, he said.
“Our ultimate goal, after all,” American surgeon and public health researcher Atul Gawande wrote in Being Mortal: Medicine and What Matters in the End, “is not a good death but a good life to the very end.”